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Article: Pacing to reduce refractory angina in patients with severe coronary artery disease: A crossover pilot trial
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TitlePacing to reduce refractory angina in patients with severe coronary artery disease: A crossover pilot trial
 
AuthorsStolen, CM5
Lam, YM4
Siu, CW1 4
Lau, CP4
Parker, JA3
Hauser, TH3
Tse, HF4 1 2
 
Issue Date2012
 
PublisherSpringer New York LLC. The Journal's web site is located at http://www.springer.com/medicine/cardiology/journal/12265
 
CitationJournal Of Cardiovascular Translational Research, 2012, v. 5 n. 1, p. 84-91 [How to Cite?]
DOI: http://dx.doi.org/10.1007/s12265-011-9326-7
 
AbstractBiventricular pacing (BiV) has been shown to reduce wall stress and workload in regions near the pacing sites. This trial investigated if BiV near the ischemic region would reduce chest pain in patients with refractory angina due to severe coronary artery disease (CAD). Eleven patients were implanted with BiV devices with leads positioned at or adjacent to their ischemic regions as detected by single-photon emission computed tomography (SPECT) and randomized to either pacing turned ON or OFF for 3 months, and then crossed over for 3 months. With pacing turned ON, a Dynamic atrioventricular (AV) delay was set for approximately 90% and 70% of the intrinsic AV delay at the resting heart rate and at the onsetof symptoms, respectively. One patient was excluded from the analysis due to a large amount of RV pacing during the OFF periods (24-64%) and due to an inability to properly deliver therapy because of an excessive number of ventricular premature complexes. Overall, with the device ON vs. OFF, the number of angina episodes (0.8±0.4 vs. 1.2±0.7 per week, P=0.03) and amount of nitroglycerin used (0.2±0.1 vs. 1.0±0.7 per week, P=0.11) was lower with BiV pacing. Furthermore, the treadmill exercise time to symptoms trended higher (427±65 vs. 408±64 s, P= 0.19), and the sum of fluorodeoxyglucose-positron emission tomography (FDG-PET) scores trended lower (7.9±3.5 vs. 12.0±4.0, P=0.11) with the device ON vs. OFF. Nevertheless, there were no significant differences in SPECT myocardial perfusion scores, left ventricle ejection fraction, wall motion score index, and quality of life scores with device programmed ON vs. OFF (all P>0.05). In conclusion, this pilot study demonstrated that BiV-P at or near the ischemic region was feasible and associated with significant reductions in angina in patients with severe CAD. Adequately powered prospective studies are needed to confirm these findings. © Springer Science+Business Media, LLC 2011.
 
ISSN1937-5387
2013 Impact Factor: 2.691
 
DOIhttp://dx.doi.org/10.1007/s12265-011-9326-7
 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorStolen, CM
 
dc.contributor.authorLam, YM
 
dc.contributor.authorSiu, CW
 
dc.contributor.authorLau, CP
 
dc.contributor.authorParker, JA
 
dc.contributor.authorHauser, TH
 
dc.contributor.authorTse, HF
 
dc.date.accessioned2012-09-05T05:31:48Z
 
dc.date.available2012-09-05T05:31:48Z
 
dc.date.issued2012
 
dc.description.abstractBiventricular pacing (BiV) has been shown to reduce wall stress and workload in regions near the pacing sites. This trial investigated if BiV near the ischemic region would reduce chest pain in patients with refractory angina due to severe coronary artery disease (CAD). Eleven patients were implanted with BiV devices with leads positioned at or adjacent to their ischemic regions as detected by single-photon emission computed tomography (SPECT) and randomized to either pacing turned ON or OFF for 3 months, and then crossed over for 3 months. With pacing turned ON, a Dynamic atrioventricular (AV) delay was set for approximately 90% and 70% of the intrinsic AV delay at the resting heart rate and at the onsetof symptoms, respectively. One patient was excluded from the analysis due to a large amount of RV pacing during the OFF periods (24-64%) and due to an inability to properly deliver therapy because of an excessive number of ventricular premature complexes. Overall, with the device ON vs. OFF, the number of angina episodes (0.8±0.4 vs. 1.2±0.7 per week, P=0.03) and amount of nitroglycerin used (0.2±0.1 vs. 1.0±0.7 per week, P=0.11) was lower with BiV pacing. Furthermore, the treadmill exercise time to symptoms trended higher (427±65 vs. 408±64 s, P= 0.19), and the sum of fluorodeoxyglucose-positron emission tomography (FDG-PET) scores trended lower (7.9±3.5 vs. 12.0±4.0, P=0.11) with the device ON vs. OFF. Nevertheless, there were no significant differences in SPECT myocardial perfusion scores, left ventricle ejection fraction, wall motion score index, and quality of life scores with device programmed ON vs. OFF (all P>0.05). In conclusion, this pilot study demonstrated that BiV-P at or near the ischemic region was feasible and associated with significant reductions in angina in patients with severe CAD. Adequately powered prospective studies are needed to confirm these findings. © Springer Science+Business Media, LLC 2011.
 
dc.description.natureLink_to_subscribed_fulltext
 
dc.identifier.citationJournal Of Cardiovascular Translational Research, 2012, v. 5 n. 1, p. 84-91 [How to Cite?]
DOI: http://dx.doi.org/10.1007/s12265-011-9326-7
 
dc.identifier.citeulike9977632
 
dc.identifier.doihttp://dx.doi.org/10.1007/s12265-011-9326-7
 
dc.identifier.epage91
 
dc.identifier.hkuros201294
 
dc.identifier.issn1937-5387
2013 Impact Factor: 2.691
 
dc.identifier.issue1
 
dc.identifier.pmid22038623
 
dc.identifier.scopuseid_2-s2.0-84859793542
 
dc.identifier.spage84
 
dc.identifier.urihttp://hdl.handle.net/10722/163476
 
dc.identifier.volume5
 
dc.languageeng
 
dc.publisherSpringer New York LLC. The Journal's web site is located at http://www.springer.com/medicine/cardiology/journal/12265
 
dc.publisher.placeUnited States
 
dc.relation.ispartofJournal of Cardiovascular Translational Research
 
dc.relation.referencesReferences in Scopus
 
dc.rightsThe original publication is available at www.springerlink.com
 
dc.subject.meshAged
 
dc.subject.meshAged, 80 And Over
 
dc.subject.meshAngina Pectoris - Etiology - Physiopathology - Radionuclide Imaging - Therapy
 
dc.subject.meshCardiac Resynchronization Therapy - Adverse Effects
 
dc.subject.meshCardiac Resynchronization Therapy Devices
 
dc.subject.meshCoronary Artery Disease - Complications - Physiopathology
 
dc.subject.meshCoronary Circulation
 
dc.subject.meshCross-Over Studies
 
dc.subject.meshEquipment Design
 
dc.subject.meshExercise Tolerance
 
dc.subject.meshFeasibility Studies
 
dc.subject.meshFemale
 
dc.subject.meshFluorodeoxyglucose F18 - Diagnostic Use
 
dc.subject.meshHong Kong
 
dc.subject.meshHumans
 
dc.subject.meshMale
 
dc.subject.meshMiddle Aged
 
dc.subject.meshMyocardial Perfusion Imaging - Methods
 
dc.subject.meshPilot Projects
 
dc.subject.meshPositron-Emission Tomography
 
dc.subject.meshPredictive Value Of Tests
 
dc.subject.meshProspective Studies
 
dc.subject.meshQuality Of Life
 
dc.subject.meshRadiopharmaceuticals - Diagnostic Use
 
dc.subject.meshRecovery Of Function
 
dc.subject.meshSeverity Of Illness Index
 
dc.subject.meshSingle-Blind Method
 
dc.subject.meshStroke Volume
 
dc.subject.meshTime Factors
 
dc.subject.meshTomography, Emission-Computed, Single-Photon
 
dc.subject.meshTreatment Outcome
 
dc.subject.meshVasodilator Agents - Therapeutic Use
 
dc.subject.meshVentricular Function, Left
 
dc.titlePacing to reduce refractory angina in patients with severe coronary artery disease: A crossover pilot trial
 
dc.typeArticle
 
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<description.abstract>Biventricular pacing (BiV) has been shown to reduce wall stress and workload in regions near the pacing sites. This trial investigated if BiV near the ischemic region would reduce chest pain in patients with refractory angina due to severe coronary artery disease (CAD). Eleven patients were implanted with BiV devices with leads positioned at or adjacent to their ischemic regions as detected by single-photon emission computed tomography (SPECT) and randomized to either pacing turned ON or OFF for 3 months, and then crossed over for 3 months. With pacing turned ON, a Dynamic atrioventricular (AV) delay was set for approximately 90% and 70% of the intrinsic AV delay at the resting heart rate and at the onsetof symptoms, respectively. One patient was excluded from the analysis due to a large amount of RV pacing during the OFF periods (24-64%) and due to an inability to properly deliver therapy because of an excessive number of ventricular premature complexes. Overall, with the device ON vs. OFF, the number of angina episodes (0.8&#177;0.4 vs. 1.2&#177;0.7 per week, P=0.03) and amount of nitroglycerin used (0.2&#177;0.1 vs. 1.0&#177;0.7 per week, P=0.11) was lower with BiV pacing. Furthermore, the treadmill exercise time to symptoms trended higher (427&#177;65 vs. 408&#177;64 s, P= 0.19), and the sum of fluorodeoxyglucose-positron emission tomography (FDG-PET) scores trended lower (7.9&#177;3.5 vs. 12.0&#177;4.0, P=0.11) with the device ON vs. OFF. Nevertheless, there were no significant differences in SPECT myocardial perfusion scores, left ventricle ejection fraction, wall motion score index, and quality of life scores with device programmed ON vs. OFF (all P&gt;0.05). In conclusion, this pilot study demonstrated that BiV-P at or near the ischemic region was feasible and associated with significant reductions in angina in patients with severe CAD. Adequately powered prospective studies are needed to confirm these findings. &#169; Springer Science+Business Media, LLC 2011.</description.abstract>
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Author Affiliations
  1. The University of Hong Kong Li Ka Shing Faculty of Medicine
  2. The University of Hong Kong
  3. Harvard Medical School
  4. Queen Mary Hospital Hong Kong
  5. Boston Scientific Corporation